5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998

Biomechanical analysis and comparison between 'Zeta' miniplate design and conventional miniplate system for fixation of fracture segments in transition zone of parasymphysis body region of mandible - an in vitro study

The parasymphysis area of the mandible is highly dynamic because it is subjected to both occlusal and muscular forces. As a result, the fractures in this transition zone have a special pattern, posing a challenge for surgeons whether to use one miniplate versus two miniplates, as per Champy's recommendations. The commonest complication resulting to treat this area is mental nerve paraesthesia due to the dissection and stretching of the nerve. Hence, an in vitro research study of a newly designed 'Zeta' miniplate is performed, to evaluate the biomechanical behaviour using finite element (FE) analysis and biomechanical analysis along with a comparison study with the conventional miniplate configurations. The results showed that the Zeta miniplate produces the lowest stresses 17.511 MPa and the least total structural deformation of 0.0011 mm after applying the maximum occlusal bite force. On application of torsional load, total structural deformation was 0.0004 mm and von Mises (VM) stress value was 0.24 MPa which was lowest when compared with the two miniplate system. Hence, the newly developed Zeta miniplate is superior in terms of stability. Another benefit of its design is that it helps in preventing mental nerve paraesthesia and tooth root damage while fixing and stabilising the fractured bony segments.

Mandibular Ramus Fractures: A Case Series of Diversity in Rarity

Mandibular ramus fracture is usually minimally displaced as it is surrounded by the medial pterygoid medially, masseter laterally, and the pterygomasseteric sling inferiorly. They are commonly caused either by road traffic accidents or interpersonal violence. Ramus fracture is usually seen in conjunction with other mandibular fractures and is seldom found alone. The ramus is located at the congregation of the dentate and the non-dentate parts of the mandible. Ramus fractures are generally managed by closed reduction when minimally displaced but this technique has its disadvantages like poor maintenance of oral hygiene and prolonged healing time. It can get fractured in various patterns. Owing to the presence of anatomical structures on either side of the ramus and the orientation of the fracture line, the treatment plan varies in each case to prevent paresthesia by preserving the inferior alveolar nerve. This article has demonstrated four distinct kinds of mandibular ramus fractures and their management with open reduction internal fixation (ORIF).

A new classification of mandibular fractures

There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II+condyle, III; body/symphysis, IIIc; III+condyle, IV; multiple fractures not including condyle, IVc; IV+condyle, V; bilateral condyle±other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18-23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.

Recurrent mandibular fractures: a retrospective study over 17 years on aetiology, demographics, fracture patterns, and management

Recurrent fractures of the mandible are rare, however in Darwin, Australia, their occurrence is relatively frequent. This retrospective study identified 127 patients with 148 recurrent mandibular fractures treated at Royal Darwin Hospital between 2000 and 2017. Age, sex, ethnicity, marital status, aetiology, risk factors, anatomical location of the fractures, fracture patterns, and management of the fractures were analysed. The majority of patients were male (85.8%) (P < 0.001); 62.8% were unmarried (P < 0.001) and 72.4% were indigenous (P < 0.001). Alcohol was involved in 79.1% of cases (P < 0.001) and assault was the most common mechanism of injury (84.5%) (P < 0.001). The angle of the mandible was the most common site (P < 0.001), and recurrent fractures were more likely to occur at sites different to a previous fracture fixation site (P < 0.001). Smoking, alcohol abuse, and diabetes were strongly associated with recurrent fractures (all P < 0.001). Most patients were managed with open reduction internal fixation. In conclusion, recurrent fractures of the mandible frequently involved the angle of the mandible and occurred at different sites. Their incidence was more common among the unmarried, male, and indigenous population, and smoking, alcohol abuse, and diabetes were found to be significant risk factors.

Fracture Injury Risk of the Restrained Mandible to Anterior-Posterior Blunt Impacts

This study describes the results of anterior-posterior impacts conducted on the mandibles of 22 male postmortem human subjects (PMHSs). The objective of this study was to develop an injury criterion for the mandible based on blunt impact while the jaw was restrained. Previous studies have attempted to characterize the injury risk of blunt impact to the mandible; however, due to the translation of the mandible during impact and a limited number of fractured specimens, previous studies were not able to produce an injury criterion. Blunt impact to a restrained mandible is relevant to a wide array of helmeted individuals, including the military population and sports that require helmets with chinstraps. Therefore, in this study, specimens were positioned with restrained jaws and impacted using a monorail drop tower with a gravity-driven cylindrical impactor. Nineteen of 22 specimens sustained at least one fracture during testing. Injury cases had an average impact energy of 15.0 ± 5.7 J (11.1 ± 4.2 ft-lb) and a fracture force of 2684 ± 726 N (603 ± 163 lbf). Results were used to generate an impactor force based injury criterion through survival analysis. Risk of injury was modeled using a Weibull distribution and a 50% risk of injury was found to occur at approximately 2834 N (637 lbf). The developed injury risk curve can be used to characterize injury to the restrained mandible for future testing and research studies, especially in the development of maxillofacial protective equipment.

Mandibular Ramus Fractures: A Proposed Classification

Aims

The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management.

Methods

Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification.

Results

A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients.

Conclusion

The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.

Management of Mandible Fracture by Plating and Wiring: An Otolaryngologist Perspective at Teritiary Care Center

The facial area is one of the most frequently injured parts of the body (Abiose in Br J Oral Maxillofac Surg 24(1):319, 1986; Adi et al. in Br J Oral Maxillofac Surg 28(3):1949, 1990; Allan and Daly in Int J Oral Maxillofac Surg 19(5):26871, 1990), and the mandible is one of the most commonly fractured maxillofacial bones (1990; Azevedo et al. in J Trauma 45(6):10847, 1998; Bremerich et al. in Acta Stomatol Belg 93:511, 1996). Mandible is the only mobile bone of the skeleton, and hence vulnerable to fracture. This is a retrospective study of 50 mandibular fracture cases managed at the Department of ENT, Govt. Medical College Bhavnagar during the 2 years period from 2014 to 2016. Maximum subjects were in age group 21-30 years with a male preponderance. Road traffic accident is the main cause followed by falls and assault. Symphysis is the most common site of Mandibular fracture. Mandible fracture is a common entity in Road traffic accidents. Multiple fractures are seen in 40% of mandibular fracture cases. The results were equally good in patients requiring only MMF (Maxillo Mandibular Fixation) and inpatients requiring MMF and Plating, during the follow up up to 8 weeks. Physiotherapy was advised for all the post op patients after 2 months.

An in-vitro evaluation of a novel design of miniplate for fixation of fracture segments in the transition zone of parasymphysis-body region of mandible using finite element analysis

The mandibular parasymphysis and body regions are highly dynamic areas. They are constantly subjected to both occlusal and muscular forces. Fractures at this transition zone of the parasymphysis and body region thus represent a special pattern that creates a dilemma for the surgeons - whether to use one miniplate fixation or two miniplates as per Champy's guidelines. Mental nerve paresthesia is a very common complication due to dissection and stretching of the mental nerve in this region. Hence, an in-vitro research study of a novel twin fork design of miniplate is performed, which evaluates the biomechanical behavior using computerized finite element analysis. A comparison is carried out with the conventional design. The results show that the twin fork miniplate produces the lowest stresses - 23.821 MPa - and the least total structural deformation after applying the maximum occlusal bite force. This study concludes that the newly designed miniplate is superior in terms of stability because it shows the least structural deformation, and produces the lowest equivalent stresses on application of maximal occlusal forces. An additional advantage is the preservation of the mental nerve during the plating procedure because the broad end of the Y shape allows atraumatic positioning of the miniplate and hence the fixation of fractured segments.

Rare Mandibular Ramus Fracture

Mandibular fractures represent approximately two-thirds of all maxillofacial fractures (nearly 70%), out of which fractures of mandibular ramus represent 3.09% which is considered to be a rare fracture site. They occur alone or in combination with other facial bone fractures resulting in loss of function and disfigurement. The pattern of mandibular fractures varies with geographic location, physical activity, social, cultural, and environmental factors. The main causes of mandibular fracture are road traffic accidents, interpersonal violence, falls, sports injuries, industrial trauma, and pathological fractures. In this clinical case, the authors describe a vertical ramal fracture extending from subsigmoid region to inferior border of angle of the mandible combined with symphysis fracture which was surgically operated through open reduction and internal fixation by extraoral approach.

C-spine injury and mandibular fractures: lifesaver broken in two spots

BACKGROUND

Trauma is a leading cause of injury and mortality and may involve mandibular fractures and cervical spine injuries. Manipulation of the spine during trauma protocols and operative treatment has the potential to cause serious spinal cord injuries. The purpose of this study was to identify risk factors associated with cervical spine injury (CSI) in patients with mandibular fractures.

METHODS

The National Trauma Databank (2007-2010) was used to identify patients with mandibular fractures.

RESULTS

A total of 59,028 patients were identified and separated into adult and pediatric cohorts. There were 50,711 adults (86%) and 8317 children (14%). There were statistically significant lower rates of associated CSI in pediatric patients than adults (3.5% versus 7.3%, P < 0.01). Predictors of associated CSI in mandible fractures for both adults and children were older age, lower Glasgow Coma Scale, thoracic injuries, firearm or motor vehicle accident mechanisms, and symphyseal fractures. In the pediatric cohort, body, ramus, and subcondylar fractures were significantly associated with CSI. In adults, female gender, and upper extremity, abdominopelvic, and head injuries were also significantly associated with CSI.

CONCLUSIONS

Multiple mandibular fractures were inversely correlated with CSI. One possibility is that energy dissipation in the mandible with multiple fractures is protective of the C-spine leading to fewer fractures. Children and adults had different associations in the pattern of mandible fractures concomitant with CSI. This has implications in management, imaging, and workup of trauma patients.

An Analysis of 3599 Midfacial and 1141 Orbital Blowout Fractures Among 4426 United States Army Soldiers, 1980–2000

OBJECTIVE

We sought to present the epidemiology associated with 3599 midfacial and 1141 orbital blowout fractures.

STUDY DESIGN AND SETTING

We conducted a multicenter, 20-year retrospective analysis of hospitalization data on U.S. Army active duty soldiers.

RESULTS

Men composed 96% of the patients, with men aged 20 to 29 years the most affected. Of midfacial and blowout fractures, 54.8% and 70.2% occurred with concomitant injury, with 36.2% and 50.9% sustaining other facial fractures, respectively. Three hundred forty orbital blowout fractures (29.8%) had an associated eye injury. Common mechanisms included fighting and motor vehicle accidents.

CONCLUSIONS

Young men comprised the most susceptible population, and assault was the predominant mechanism. A high incidence of concomitant injury in midfacial and orbital blowout fractures, particularly ocular and intracranial injury, emphasizes the importance of a thorough physical examination.

SIGNIFICANCE

We report the results from one of the largest series of midfacial and orbital floor blowout fractures from a population that crosses urban, rural, and foreign boundaries.

Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%). In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA) n = 07 (58.33%) followed by fall n = 04 (33.33%) and assault n = 1 (8.33%). The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.

A study of mandibular fractures over a 5-year period of time: A retrospective study

Objective:

This study aims to evaluate and compare with the existing literature on the etiology, pattern, gender, and anatomical distribution of mandibular fractures.

Materials and Methods:

The data of 225 cases were analyzed over a period of 5 years between March 2009 and November 2013. Of this 110 were unilateral, 23 bilateral, 18 symphysis and 74 multiple fractures.

Results:

Males are more affected than females. The peak incidence rate is occurring in 30-35 years of age group. The most common fracture site is parasymphysis and least common site is ramus of mandible. The most common etiological factor is road traffic accident (RTA) (45.3%) followed by falls (42.6%), assaults (8.9%), sport injuries (2.2%), and gunshot wounds (0.89%).

Conclusion:

Thus, we conclude that RTA is the leading cause of mandibular fractures and males are more affected. The most common site is parasymphysis fracture in association with angle fracture. We observed that gender was significantly associated with body and angle fracture (P = 0.04) and significant relationship between etiology with multiple site fracture such as (parasymphysis-angle), (body-condyle), (body-angle), and (symphysis-condyle) was observed (P ≤ 0.05).

Unusual unilateral fracture of the condylar and coronoid processes of the mandible

The incidence of condylar fracture is very high and most are not caused by direct trauma. On the other hand, fracture of the coronoid process is reported less often than fracture of other parts of the mandible. We report a case of right subcondylar and coronoid fractures without any evidence of direct trauma to the zygomatic area or an indirect trauma to the mandibular corpus or sypmheseal region. The possible cause was identified as acute reflex contraction of the temporalis muscles leading to coronoid and condylar stress fractures.

A Prospective Study of Strut versus Miniplate for Fractures of Mandibular Angle

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients were randomly assigned to receive the strut plate or Champy miniplate for angle fracture fixation. Patient demographics, fracture characteristics, operative and postoperative outcomes were collected prospectively. Statistical analysis was performed to evaluate the significance of the outcome. A total of 18 patients were included in this study and randomly assigned to receive either the strut plate or Champy miniplate. Out of which five patients were excluded postoperatively due to complex fracture resulting in postoperative maxillomandibular fixation. The final enrollment was 13 patients, N = 6 (strut) and N = 7 (Champy). There was no statistically significant difference in the pretreatment variables. Nine of these patients had other associated facial fractures, including parasymphyseal and subcondylar fractures. Most of the (11) patients had sufficient follow-up after surgery. Both groups exhibited successful clinical unions of the mandibular angle fractures. The complications associated with the mandibular angle were 20% in the strut plate group and 16.7% in the Champy group. One patient in the strut plate group had a parasymphyseal infection, requiring hardware removal. The strut plate demonstrated comparable surgical outcome as the Champy miniplate. It is a safe and effective alternative for management of mandibular angle fracture.

Biomechanical properties of the body and angle of the sheep mandible under bending loads

AIM

The aim of the study was to compare the body and angle of the sheep mandible in terms of bone density and biomechanical competence under bending load conditions.

MATERIAL AND METHODS

Nineteen sheep mandibles were used in this study. The mandibles were separated at the symphysis into two halves. Three regions of interest on the body and angle of the hemi-mandibles were selected for measurements of bone mineral density (g cm(-2) ) by dual energy X-ray absorbtiometry. Biomechanical properties of the left mandibular body and right mandibular angle were measured by three-point bending test using a material testing machine. The load and deformation were recorded, and the load-deformation curves were obtained. The values of failure load (FL), yield load (YL), yield deformation (YD), postyield deformation (PD), stiffness, energy to yield point (EY) and energy to failure point (EF) were calculated with the analysis of load-deformation curves. Groups were compared using independent samples Student's t-test.

RESULTS

The mandibular angle exhibited the lower bone density (-64%) and biomechanical properties (FL; -45%, YL; -40%, PD; -7% stiffness, -40% EY; -48% and EF; -34%) than the mandibular body under bending loads, and there was no significant difference in values of YD between the two regions.

CONCLUSION

Our results show that the mandibular angle is weaker than the mandibular body under bending loads.

1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil

OBJECTIVE

To analyze the mandibular fractures which presented over a 3-year period at an emergency hospital in Belo Horizonte, Brazil.

METHODS

The data collected included age, sex, aetiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture, and treatment. The analysis involved descriptive statistics and the Pearson's chi-square, Bonferroni, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests, and analysis of variance.

RESULTS

There were 1,454 mandibular fractures in 1,023 patients. Males of 20-29 years of age sustained the majority of fractures. Traffic accidents were the major causes of trauma, followed by violence and falls. A high incidence of fractures in women due to violence was observed. The condyle region was found to be the most common fracture site in the mandible. A surgical approach was performed in most cases. There were more accidents causing mandibular fractures on the weekends.

CONCLUSION

The individuals with mandibular fractures due to "traffic accidents" were younger than those due to "violence" and "falls". There was a significant statistical association between age and aetiology as well as between sex and aetiology of mandibular fractures.

National hardware removal rate associated with internal fixation of facial fractures

PURPOSE

There has not been a broad national examination of complications and demographics of facial trauma reduction procedures. The literature has reported acceptable and unacceptable hardware removal rates in localized populations.

MATERIALS AND METHODS

The 2007 Nationwide Inpatient Sample was used to determine all plate removal procedures associated with common complications from facial reductions. Statistical analysis was used to compare the differences in demographics of the reduction procedure and removal procedure groups.

RESULTS

Some form of open fixation was reported in 4,879 patients. Plate removals associated with complications were reported in 246 patients. The "failure" removal rate as a percentage of the total number of open procedures for the year was 5.0%. Gender, race, age, primary payer, and median income of the patient were determined to significantly affect the likelihood for hardware removal due to complications.

CONCLUSION

These results suggest that decreased lower bone quality and ability to pay affect the chances that a particular patient will undergo a hardware removal procedure. There is a strong possibility that the reported removal rate underestimates the actual failure rate of the procedures and devices used to treat facial trauma.

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

OBJECTIVE

The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients.

MATERIAL AND METHODS

Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications.

RESULTS

532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation.

CONCLUSION

There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

Estudo epidemiológico das fraturas mandibulares em hospital público da cidade de São Paulo

OBJETIVO: Analisar a frequência epidemiológica de fraturas mandibulares correlacionando gênero, faixa etária, fatores etiológicos, localização anatômica, e tipos de traços de fratura. MÉTODOS: Estudo retrospectivo nos prontuários de 883 pacientes portadores de fraturas faciais, atendidos no Pronto Socorro do Hospital Geral de Vila Penteado, pelo Serviço de Cirurgia e Traumatologia Buco Maxilo Facial (São Paulo - Brasil), num período de três anos (janeiro de 2004 a dezembro de 2006). RESULTADOS: Dos 883 pacientes avaliados, 270 apresentaram fraturas mandibulares (30,5 %). O gênero masculino foi o mais acometido (76,7%) na faixa etária de 20 a 29 anos (33,0%), o fator etiológico de maior freqüência foi acidente com veículos automotores (35,2%), o corpo da mandíbula foi a localização anatômica mais atingida (47,4%) e os traços únicos prevaleceram (76,7%). CONCLUSÃO: As fraturas, em sua maioria, foram simples (traço único), localizadas em corpo mandibular, e destacadas no sexo masculino, na faixa etária de 20 a 29 anos, além do que o fator etiológico mais comum foi acidente com veículos automotores.

Treatment of patients with double unilateral fractures of the mandible

PURPOSE

To analyze the outcomes of treatment for double unilateral mandibular fracture.

MATERIALS AND METHODS

Retrospective chart review of patients who were treated between 1994 and 2004 for 2 mandibular fractures on the same side of the mandible. Data collected involved age, gender, race, cause of fracture, treatment modality, length of follow-up, occlusal relationship at last visit, preoperative and postoperative clinical photographs and radiographs, and incidence and management of complications. Standard descriptive statistics were used.

RESULTS

From a total of 1,287 mandibular fractures for which charts were available, 31 double unilateral mandibular fractures were treated during a 10-year period, for an occurrence rate of 2.4%. Demographic characteristics of these patients were similar to those of patients in other published studies on mandibular fracture. Fractures involved angle + body (18/31, 58%), condyle + body (11/31, 35%), and condyle + angle (2/31, 6%). Various treatments were provided for these fractures, but open reduction and internal fixation were applied to at least 1 of the fractures. Follow-up ranged from 6 weeks to 5 months (average, 9.6 weeks). Eight patients (8/31, 25.8%) developed complications involving visible gonial flaring; 3 of these also had cross-bite.

CONCLUSION

Double unilateral mandibular fracture is a rare event. The difficulty inherent in treating these fractures can be alleviated with the use of proper techniques of open reduction and internal fixation; however, treatment continues to be associated with a high complication rate.

Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.

Maxillofacial fractures in Southern Bulgaria – A retrospective study of 1706 cases

The present retrospective study investigated various types, aetiology, complications and methods of treatment of maxillofacial fractures managed in the Department of Maxillofacial Surgery, Medical University, Plovdiv, Bulgaria.

PATIENTS AND METHODS

A total of 1706 patients were studied with 2534 fractures treated between 1994 and 2003. The analysis included data on age and gender of patients, causes and types of fractures (mean number of fractures per patient - 1.48) as well as the treatments used and the associated complications.

RESULTS

Most maxillofacial fractures were sustained by 574 men (age range 21-30 years). The ratio of males to females was 4.6:1. Most fractures were caused by violent assault - 1040 (61%), followed by motor vehicle accidents - 264 (15.5%), fall - 213 (12.5%) and bites from animals - 72 (4%). Fractures of the mandible were sustained by 1261 patients (74%), fractures of the maxilla by 97 (6%), fractures of the zygomatic bone by 277 (16%), nasal fractures by 63 (4%) and multiple fractures by 8 (0.5%). In 1330 (77%) patients the fractures were treated by closed reduction; in 264 patients (16%) by open reduction and fixation, and for the remaining 112 patients (7%) were managed with combined closed and open reduction. The mortality rate was 0.2%, the lethal cases being a result of a combination of severe fractures in the maxillofacial region and trauma to other organs/systems.

CONCLUSION

The most common cause of traumatic injury in the maxillofacial region in this study sample was assault, predominantly affecting men. The fractures were treated using various methods but mostly by closed reduction plus fixation.

Fracture of the coronoid and pterygoid processes by firearms: case report

A rare case of fracture of the coronoid and the pterygoid process caused by firearms is described. A 28-year-old male was hit by a bullet in the face, resulting in restricted mouth opening, difficulty in chewing and pain when opening the mouth. Clinical examination revealed a perforating wound in the right parotid region and a similar wound on the left side of the same region. A CT scan showed comminuted fracture of the left coronoid process and bilateral comminuted fracture of the pterygoid processes. Treatment was conservative, speech therapy was conducted and it was successful. Details of the clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.

A comparative study of most suitable miniplate fixation for mandibular symphysis fracture using a finite element model

The purpose of this study is to determine the most stable fixation method for mandibular symphysis fractures by comparing the mechanical characteristics of models fixed at different positions with different numbers of plates. Fractures were generated in 3-dimensional finite element models, and were fixed with a single miniplate, parallel double miniplates, or perpendicular double miniplates. A 300 N perpendicular load was then applied on the left molar region, and a finite element analysis was performed. We compared vertical gaps between the fractured surfaces, maximum stress within the screw/plating system, and maximum stress around screw holes in the bone. Compared to the single miniplate, both the parallel and perpendicular double miniplates demonstrated significantly less stress in the screw/plating system and screw holes in the bone. In addition, the perpendicular double miniplateshad significantly smaller vertical gaps between fracture surfaces when compared to the single miniplate. Comparing parallel and perpendicular double miniplate fixations, less stress was found around the screw holes of the perpendicular miniplate models than those of the parallel miniplatemodels. There were no differences in vertical gaps or maximum stress within the screw/plating systems between the 2 double miniplate fixations. These results suggest that perpendicular double miniplate fixation is more suitable for fixing mandibular symphysis fractures.

Fratura de mandíbula: análise de 293 pacientes tratados no Hospital de Clínicas da Universidade Federal de Uberlândia

A fratura de mandíbula ocupa o segundo lugar entre as fraturas dos ossos da face, tendo havido aumento significativo de casos nos últimos anos. A não-identificação e o tratamento inadequado podem levar à deformidade estética ou funcional permanente. OBJETIVO: Avaliar os casos submetidos à redução de fratura de mandíbula no Hospital de Clínicas da Universidade Federal de Uberlândia, entre janeiro de 1974 e dezembro de 2002. FORMA DE ESTUDO: coorte historica. PACIENTES E MÉTODO: Duzentos e noventa e três pacientes foram submetidos à redução de fratura de mandíbula e retrospectivamente foram avaliados segundo fatores relacionados a: paciente, trauma, quadro clínico e tratamento cirúrgico. RESULTADOS: Houve uma clara tendência de aumento do número de fraturas de mandíbula ao longo dos anos. Houve um predomínio no sexo masculino (4:1), com pico de ocorrência entre 20 a 29 anos. As principais causas de fratura da mandíbula neste estudo foram acidentes de trânsito e violência, perfazendo juntas 72,4%. Cento e trinta e cinco pacientes apresentavam fratura única. Os sítios mais acometidos foram, em ordem decrescente, sínfise, côndilo, ângulo, corpo, ramo e processo coronóide. Foram realizadas redução incruenta (28), cruenta (213) e associação das duas (11 pacientes), sendo que 56,8% dos pacientes foram tratados nos primeiros 3 dias e 50,4% recebeu a alta hospitalar até o primeiro pós-operatório. Cerca de 10% dos pacientes apresentaram complicações, sendo osteomielite a mais freqüente. CONCLUSÃO: A incidência de fraturas de mandíbula foi marcadamente maior no sexo masculino, durante a terceira década de vida. A causa mais comum foi o acidente de trânsito e as regiões mais atingidas foram sínfise e côndilo. As fraturas isoladas de mandíbula ocorreram em mais de metade dos casos. A maioria dos pacientes foi tratada nos primeiros três dias e recebeu alta até o primeiro pós-operatório. A redução cruenta foi tratamento mais comumente empregado. A complicação mais freqüente foi a osteomielite.

Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia

Mandibular fracture is the second most common facial fracture and there has been a significant increase in number of cases in the last years. Misidentification and inadequate treatment can take to permanent aesthetic or functional deformity. Aim: Evaluate cases of mandibular fracture reduction in the Hospital of Clinics of the Federal University of Uberlândia, from January of 1974 to December of 2002. Study design: historical cohort. Patient and Method: Two hundred and ninety-three cases of reduction of mandibular fractures were retrospectively analyzed according to factors related to: patient, trauma, signs and symptoms, and surgical treatment. Results: There has been a clear tendency of increase of the number of mandibular fractures along the years. There was higher prevalence in male (4:1), with occurrence peak between 20 to 29 years old. The principal causes of fracture in this study were traffic accidents and violence, representing 72.4%. One hundred and thirty-five patients presented only one fracture. The most injured sites were, in decreasing order, symphysis, condyle, angle, body, ramus, and coronoid. We performed closed reduction (28), open reduction (213) and association of the two (11 patients); 56.8% of the patients were treated within the first 3 days; and, 50.4% were discharged from the hospital until the first postoperative day. About 10% of the patients presented complications, being osteomyelitis the most frequent one. Conclusion: The incidence of mandibular fractures was remarkably larger in the male sex, during the third decade of life. The most common cause was traffic accident, and symphysis and condyle were the most injured sites. Isolated fractures occurred in over half of the cases. Most of the patients were treated in the first three days and were discharged until the first postoperative visit. Closed reduction was the treatment most commonly employed. The most frequent complication was osteomyelitis.

Fracture Patterns and Bone Healing in Recurrent Mandibular Fractures: A Clinical Study of 13 Patients

BACKGROUND

Recurrent fractures of the previously treated fractured mandible are rare.

METHODS

In this retrospective study, 13 cases of repeated mandibular fractures were evaluated according to age, sex, cause, fracture localizations and patterns, treatment modalities, and complications.

RESULTS

All of the patients were men, with a mean age of 27.5 years and 32 years for the first and the subsequent fractures, respectively. The mean time interval between fractures was 4.3 years. In 10 cases, the cause for the second fracture was an assault, with 90 percent related to alcohol intake. Angle, body, and parasymphysis region of the mandible were the most common sites to be involved in the first occasion. In 10 cases, an internal rigid fixation procedure was performed for the treatment. In the recurrent injuries, none of the fractures occurred at exactly the same anatomical site. Fractures were either in the neighboring side or the contralateral side of the previously healed area of mandible. On the second occasion, angle fractures were common and body and subcondylar fracture rates increased. At second presentation, the complication rate increased from 23.1 percent to 53.8 percent and most commonly involving malocclusion.

CONCLUSIONS

This study showed that assault is the major etiologic factor for recurrent mandible fractures and that these fractures occur in different locations from the original injury. They necessitate a cautious approach for the prevention of unfavorable outcomes. Further retrospective clinical and experimental studies are necessary to elucidate the fracture patterns and bone-healing quality of these recurrent mandible fractures.

Treatment of mandibular angle fractures with a matrix miniplate: a preliminary report

Mandibular angle fractures are technically challenging, and a spectrum of techniques for treatment of these fractures has been proposed in the literature. Currently, fixation with one or two miniplates has become a widely accepted method of providing internal fixation and eliminating the need for postoperative maxillomandibular fixation. In this study, the utility of a single 2.0-mm matrix miniplate for mandibular angle fracture management was examined. In a laboratory biomechanical analysis, the overall stability of the single 2.0-mm matrix miniplate compared favorably with two 2.0-mm miniplates in a simulated fracture setting. The matrix miniplate demonstrated an overall better intrinsic stability, more resistance to out-of-plane fracture movement, and a higher load tolerance when motion out-of-plane was challenged. Clinically, the matrix miniplate performed well. In a series of 22 consecutive patients, there were no cases of nonunion, malunion, or plate failure. Two patients developed infection that was managed in both cases by drainage with maintenance of the miniplate. Both went on to full union. These results compare very favorably to previously published series using one or two miniplates.

Mandible fracture patterns: a suburban trauma center experience

PURPOSE

Mandible fractures are among the most frequently seen injuries in the trauma center setting. Recent shifts in the mechanism and age distribution of patients sustaining these injuries are well documented. This study attempts to define current, predictable patterns of fracture based on patient characteristics and mechanism of injury.

MATERIAL AND METHODS

The charts of 134 patients with 225 mandible fractures treated over a 7-year period by the Otolaryngology-Head and Neck Surgery, Plastic and Reconstructive Surgery and Oral-Maxillofacial Surgery services, our institution, were retrospectively reviewed. Patients were categorized based on age, mechanism of fracture, and anatomic location of fracture. Multivariate analysis of data was performed to determine significant relationships among groups.

RESULTS

Violent crimes such as assault and gunshot wounds accounted for the majority of fractures (50%) in this study, with motor vehicle accidents less likely (29%). Overall, parasymphyseal fractures were most frequent (35%), whereas angle and body fractures were also common (15% and 21%, respectively). There was a statistically significant association of motor vehicle accidents with parasymphyseal fractures (45%), and gunshot wounds with body fractures (36%), whereas assault victims had a higher than predicted frequency of angle fractures (27%) and fewer parasymphyseal fractures (19%). Patients aged 17 to 30 were more likely to suffer from gunshot wounds, whereas older adults (age 31-50) were more likely to be assault victims. Patients over age 50 suffered fractures from falls at a higher than expected rate. Although children and young adults seemed to suffer more parasymphyseal fractures and older adults body fractures, these correlations failed to show statistical significance. Parasymphyseal fractures were most frequently associated with fractures at other sites within the mandible, ipsilateral body fractures being the most common.

CONCLUSIONS

Updated data on the association of patient age and mechanism of injury with fracture pattern can guide treating physicians in anticipating and diagnosing traumatic mandible fractures.

Diagnosis and initial management of laryngotracheal injuries associated with facial fractures

INTRODUCTION

Laryngotracheal injuries are uncommon with an estimated incidence of 1 per thousand (1-6 patients per 15000-42500 trauma victims). They may be associated with fractures of the facial skeleton. Their symptoms are variable ranging from obvious airway obstruction to minor or almost missing symptoms. Early diagnosis and proper initial management may sometimes be difficult or delayed.

PATIENTS

Three patients with maxillofacial fractures and concomitant laryngotracheal injuries are presented. The diagnostic procedures used and the management of these injuries are reported.

DISCUSSION AND CONCLUSION

Due to their low incidence and their hidden nature laryngotracheal injuries may pose diagnostic problems, especially in polytraumatized or intubated patients. Subcutaneous emphysema is the chief clinical sign. Fibreoptic endoscopy is the most important and informative diagnostic examination. Radiographic evaluation by CT scan provides additional information about the extent of the injury and the indication for surgery. A coordinated team approach is necessary for proper management of these injuries.

Maxillofacial fractures in Hamedan province, Iran: a retrospective study (1987–2001)

BACKGROUND

This study presents the various types, causes and incidence, along with their clinical management and associated complications of maxillofacial fractures at an emergency hospital in Hamedan, Iran.

PATIENTS AND METHODS

A total of 2268 patients with 3107 facial fractures treated between 1987 and 2001, were retrospectively analysed. The average number of fractures for each patient was 1.37. Data on the patient's age, gender, cause, site, treatment modalities and trauma-associated complications were recorded and assessed.

RESULTS

Men 21-30 years of age sustained the most facial fractures. The ratio of male to female was 3.8:1. The age range was 4 months to 90 years (mean 24.6 years). Most fractures were caused by motor vehicle accidents (60%, 1360 pts), followed by falls (18.9%, 429 pts), and assaults (10%, 227 pts). Isolated mandibular fractures (52.6%, 1194 pts) were most common, followed by isolated mid-facial fractures (29.5%, 669 pts) and alveolar process fractures (15.1%, 342 pts). 70.8% of patients were treated by closed reduction, 17.8% with open procedures and 11.4% using both. Complications resulting directly from trauma occurred in 5.5% of patients.

CONCLUSION

The findings support the view that both the causes and incidence of maxillofacial fractures vary from one country to another.

Etiology and patterns of facial fractures in the United Arab Emirates

A retrospective study on facial fractures was carried out in the Department of Oral and Maxillofacial Surgery at Tawam Hospital (Al Ain, United Arab Emirates) between January 1, 1998 and December 31, 2001. The study included 144 patients with a mean age of 26.5 years; the most frequently injured patients belonged to the 16- to 20-year-old age group. The male predilection was 83%. Road traffic accident was the most common causative factor (59%), followed by falls (21.5%), accidents where camels were involved (5.5%), work- and sport-related accidents (4.8% and 4.8%, respectively), and assault (4.1%). A total of 53.4% of the patients suffered isolated mandibular fractures, 32.6% had isolated midface fractures, and 13.8% had combined midface and mandibular fractures. Associated injuries were noted in 22.2% of the patients. The number of patients treated increased from 28.3 (1990-1995) to 36 (1998-2001) on an annual average; a reduction in isolated nasal fractures and associated injuries, including facial lacerations, was noted with no change in age or etiology predilection. Sufficient data could not be obtained to determine if the favorable results with the associated injuries were a result of the effect of a compulsory seat belt law introduced on June 1, 1998, but the increasing number of maxillofacial injuries suggests that the seat belt law is ignored in this country.